| Active Integrated Medicine | |
|
329 E Platte Ave Fort Morgan CO 80701-3172 | |
| (970) 441-1117 | |
| Not Available |
| Full Name | Active Integrated Medicine |
|---|---|
| Speciality | General Practice |
| Location | 329 E Platte Ave, Fort Morgan, Colorado |
| Authorized Official Name and Position | Leif Stephens (ADMINISTRATOR) |
| Authorized Official Contact | 9704585216 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Integrated Medicine 329 E Platte Ave Fort Morgan CO 80701-3172 Ph: (970) 441-1117 | Active Integrated Medicine 329 E Platte Ave Fort Morgan CO 80701-3172 Ph: (970) 441-1117 |
| NPI Number | 1174016331 |
|---|---|
| Provider Enumeration Date | 06/12/2018 |
| Last Update Date | 02/23/2024 |
| Medicare PECOS PAC ID | 4688914526 |
|---|---|
| Medicare Enrollment ID | O20190313000291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174016331 | NPI | - | NPPES |
| 1346781846 | Other | CO | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Leif A Stephens |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1770733297 PECOS PAC ID: 5395802870 Enrollment ID: I20090327000278 |
| Provider Name | Sandra J Boone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346781846 PECOS PAC ID: 6507137593 Enrollment ID: I20170809003272 |
| Provider Name | Shenae Marcene Kembel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033747787 PECOS PAC ID: 0446669329 Enrollment ID: I20210505000962 |
| Provider Name | Manuel Nunez |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1942657309 PECOS PAC ID: 2961879929 Enrollment ID: I20221103001184 |
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